Abstract: Objective To explore the clinical characteristics,early diagnosis and treatment strategies of arterial massive hemorrhage following the tension-free vaginal tape (TVT) procedure for stress urinary incontinence (SUI).Methods A retrospective analysis was conducted on the clinical data of a 54-year-old female patient with SUI who suffered from arterial massive hemorrhage after TVT.Meanwhile,a systematic search of relevant literature was performed to summarize the incidence rate,high-risk factors,and core points of clinical diagnosis and treatment for arterial hemorrhage after TVT.Results The patient developed sudden hemorrhagic shock two hours after the operation,accompanied by lower abdominal distension,hypotension and a significant decrease in hemoglobin level.Iliac artery angiography identified a branch of the right internal pudendal artery as the responsible lesion for bleeding,and emergency hemostasis was performed via coil combined with gelatin sponge particle embolization.Postoperative CT examination indicated the formation of a large pelvic hematoma,and the patient’s condition stabilized after subsequent symptomatic and supportive treatment.A 6-month follow-up showed complete absorption of the pelvic hematoma,complete relief of urinary incontinence symptoms,and the therapeutic effect of the TVT procedure remained unaffected.Conclusion Arterial massive hemorrhage after TVT is a rare but acute and life-threatening complication that can rapidly progress to hemorrhagic shock.Clinicians should be highly alert to the possibility of arterial hemorrhage when patients present with shock combined with lower abdominal distension after TVT.Emergency angiography combined with interventional embolization can quickly identify the bleeding site and achieve effective hemostasis,while maximizing the preservation of the therapeutic effect of the sling procedure,which can be recommended as the first-choice diagnosis and treatment plan for this complication.

Key words: stress urinary incontinence, tension-free vaginal tape, complication, embolization